Validation of diabetes mellitus and hypertension diagnosis in computerized medical records in primary health care

<p>Abstract</p> <p>Background</p> <p>Computerized Clinical Records, which are incorporated in primary health care practice, have great potential for research. In order to use this information, data quality and reliability must be assessed to prevent compromising the validity of the results.</p> <p>The aim of this study is to validate the diagnosis of hypertension and diabetes mellitus in the computerized clinical records of primary health care, taking the diagnosis criteria established in the most prominently used clinical guidelines as the gold standard against which what measure the sensitivity, specificity, and determine the predictive values.</p> <p>The gold standard for diabetes mellitus was the diagnostic criteria established in 2003 American Diabetes Association Consensus Statement for diabetic subjects. The gold standard for hypertension was the diagnostic criteria established in the Joint National Committee published in 2003.</p> <p>Methods</p> <p>A cross-sectional multicentre validation study of diabetes mellitus and hypertension diagnoses in computerized clinical records of primary health care was carried out. Diagnostic criteria from the most prominently clinical practice guidelines were considered for standard reference.</p> <p>Sensitivity, specificity, positive and negative predictive values, and global agreement (with kappa index), were calculated. Results were shown overall and stratified by sex and age groups.</p> <p>Results</p> <p>The agreement for diabetes mellitus with the reference standard as determined by the guideline was almost perfect (κ = 0.990), with a sensitivity of 99.53%, a specificity of 99.49%, a positive predictive value of 91.23% and a negative predictive value of 99.98%.</p> <p>Hypertension diagnosis showed substantial agreement with the reference standard as determined by the guideline (κ = 0.778), the sensitivity was 85.22%, the specificity 96.95%, the positive predictive value 85.24%, and the negative predictive value was 96.95%. Sensitivity results were worse in patients who also had diabetes and in those aged 70 years or over.</p> <p>Conclusions</p> <p>Our results substantiate the validity of using diagnoses of diabetes and hypertension found within the computerized clinical records for epidemiologic studies.</p

Influência de fatores psicossociais na doença de Crohn

Objetivo: Conocer la influencia de los factores psicosociales en la enfermedad de Crohn. Metodología: Se utilizó la Escala de Estrés Percibido, la Escala de Apoyo Social Percibido y la Escala Multidimensional de Locus de Control. Se recopilaron los datos de pacientes con enfermedad de Crohn – en fase de brote y quiescencia - y sanos. Los niveles de estos factores se compararon para conocer su impacto en la enfermedad de Crohn. Resultados: Diferencias estadísticamente significativas se encontraron en las tres variables en los grupos. Los pacientes con enfermedad de Crohn en fase de brote percibieron los niveles de estrés más altos. Los pacientes con enfermedad de Crohn que estaban en fase de recidiva presentaron los mayores niveles de apoyo social, identificándose el efecto modulador que tiene esta variable sobre el estrés. Y, por último, los pacientes con enfermedad de Crohn con brote presentaron mayor nivel de locus de control externo. Conclusión: Son necesarias intervenciones enfermeras en la enfermedad de Crohn relacionadas con mayor manejo del estrés, aumento del apoyo social y disminución del locus de control externo.Objective: To know the influence of psychosocial factors in the Crohn´s disease. Methodology: The Perceived Stress Scale, Scale of Social Support Perceived and Multidimensional Scale of Locus of Control was used. Data was collected from patients with Crohn´s disease -in outbreak and quiescence phase- and healthy. The levels of these factors were compared to know its impact in the Crohn´s disease. Results: Statistically significant differences found in the three variables in the groups. Patients with Crohn's disease outbreak phase perceived the highest stress levels. Patients with Crohn's disease who were in the relapse phase had the highest levels of social support, identifying the modulating effect that this variable has on stress. And finally, patients with Crohn's disease with outbreak had a higher level of external control locus. Conclusion: Nurse interventions are necessary in the Crohn´s disease therapy in order to better manage the stress, increase the social support network and change the locus of control, decreasing the external locus of control.Objetivo: Conhecer a influência de fatores psicossociais na doença de Crohn. Metodologia: Utilizou-se a Escala de Estresse Percebido, Escala de Apoio Social Percebido e Escala Multidimensional de Lócus de Controle. Os dados foram coletados de pacientes com doença de Crohn – em fase de cessação e quiescência - e saudáveis. Os níveis desses fatores foram comparados para conhecer seu impacto na doença de Crohn. Resultados: Diferenças estatisticamente significantes foram encontradas nas três variáveis nos grupos. Pacientes com doença de Crohn na fase de exacerbação perceberam os maiores níveis de estresse. Pacientes com doença de Crohn em fase de remissão apresentaram os maiores níveis de suporte social, identificando o efeito modulador dessa variável no estresse. E finalmente, os pacientes com doença de Crohn exacerbaçao tinham um nível mais alto de locus de controle externo. Conclusão: As intervenções do enfermeiro são necessárias na terapia da doença de Crohn para melhor manejo do estresse, aumento da rede de apoio social e mudança do locus de controle, diminuindo o locus de controle externo

Effectiveness of standardized Nursing Care Plans in health outcomes in patients with type 2 Diabetes Mellitus: a two-year prospective follow-up study.

Implementation of a standardized language in Nursing Care Plans (SNCP) allows for increased efficiency in nursing data management. However, the potential relationship with patientś health outcomes remains uncertain. The aim of this study was to evaluate the effectiveness of SNCP implementation, based on North American Nursing Diagnosis Association (NANDA) and Nursing Interventions Classification (NIC), in the improvement of metabolic, weight, and blood pressure control of Type 2 Diabetes Mellitus (T2DM) patients.A two-year prospective follow-up study, in routine clinical practice conditions. 31 primary health care centers (Spain) participated with 24,124 T2DM outpatients. Data was collected from Computerized Clinical Records; SNCP were identified using NANDA and NIC taxonomies. Descriptive and ANCOVA analyses were conducted.18,320 patients were identified in the Usual Nursing Care (UNC) group and 5,168 in the SNCP group. At the two-year follow-up, the SNCP group improved all parameters except LDL cholesterol and diastolic blood pressure. We analyzed data adjustming by the baseline value for these variables and variables with statistically significant differences between groups at baseline visit. Results indicated a lowering of all parameters except HbA1c, but a statistically significant reduction was only observed with diastolic blood pressure results. However, the adjusted reduction of diastolic blood pressure is of little clinical relevance. Greater differences of control values for diastolic blood pressure, HbA1c, LDL-cholesterol and Body Mass Index were found in the SNCP group, but only reached statistical significance for HbA1c. A greater proportion of patients with baseline HbA1c ≥7 decreased to <7% at the two-year follow-up in the SNCP group than in the UNC group (16.9% vs. 15%; respectively; p = 0.01).Utilization of SNCP was helpful in achieving glycemic control targets in poorly controlled patients with T2DM (HbA1c ≥7%). Diastolic blood pressure results were slightly improved in the SNCP group compared to the UNC group.ClinicalTrials.gov NCT01482481

Trends in hypertension prevalence, awareness, treatment and control in an adult type 2 diabetes Spanish population between 2003 and 2009.

In patients with type 2 diabetes, the prevalence of hypertension is higher than in non-diabetic subjects. Despite the high cardiovascular risk involving hypertension in these patients, its prevalence and control are not well known. The aims of this study were: to estimate the hypertension prevalence, awareness, treatment and control in Spanish adults with type 2 diabetes attended in Primary Care; and to analyse its time trend from 2003 to 2009. A serial cross-sectional study from 2003 to 2009 was performed in 21 Primary Care Centres in Madrid. The study population comprised all patients with diagnosed type 2 diabetes in their computerised medical history. Overall annual prevalence during the period 2003-2009 was calculated from and according to sex and age groups. Linear trend tests, regression lines and coefficients of determination were used. In 2003 89.78% (CI 87.92-91.64) of patients with type 2 diabetes suffered hypertension and 94.76% (CI: 92.85-96.67) in 2009. This percentage was greater for women and for patients over 65 years old. 30% of patients suffered previously undiagnosed hypertension in 2003 and 23.1% in 2009. 97% of diagnosed patients received pharmacological treatment and 28.79% reached the blood pressure objective in 2009. The average number of antihypertensive drugs taken was 2.72 in 2003 and 3.27 in 2009. Only 5.2% of patients with type 2 diabetes show blood pressure levels below 130/80 mmHg. Although significant improvements have been achieved in the diagnosis and control of hypertension in people with type 2 diabetes, these continue to remain far from optimum

Associated factors with HbA1c <7% in 12,800 DM patients with baseline HbA1c≥7%: logistic regression model.

<p>UNC: Usual Nursing Cares; SNCP: Standardized Nursing Care Plans; HbA1c: Glycated hemoglobin.</p

Mean values (SD) and changes of baseline and final parameters in both groups.

<p>UNC: Usual Nursing Cares; SNCP: Standardized Nursing Care Plans; Hba1c: Glycated hemoglobin; LDL: Low-density lipoprotein; SBP: Systolic Blood Pressure; DBP: Diastolic blood pressure; BMI: Body mass index.</p